Health Plan Weekly

“AI can be used for good or for evil,” stated CMS administrator nominee Mehmet Oz, M.D., during his recent Senate confirmation hearing. Appearing before the Senate Finance Committee on March 14, Oz repeatedly heralded the abilities of artificial intelligence to improve patient care and address fraud, waste and abuse. But reports of Medicare Advantage insurers’ alleged misuse of AI have also eclipsed what many exhibitors and speakers at the recent RISE National 2025 conference view as AI’s potential to be transformative.

Technology in health care has greatly evolved in the last decade, and while the industry is rapidly adopting time-saving tools and predictive analytics that can save lives, it is reaching an “inflection point,” observed Robby Sikka, M.D., in a keynote session at the industry conference, which was held March 11-14 in San Antonio, Texas. Sikka is an anesthesiologist and tech innovator who uses analytics to help sports teams predict athletes’ risk of injuries.

Texas Attorney General Ken Paxton said on March 27 that he has launched an investigation into a Centene Corp. subsidiary’s use of private investigators to spy on officials and private citizens. Paxton, a Republican, noted that Superior HealthPlan CEO Mark Sanders admitted during a March 26 public hearing— held by the Texas House of Representatives — that he hired and directed the investigators to gather information on lawmakers, journalists and consumers who were fighting to get their insurance claims paid. Superior is one of several health plans that participate in Texas’ STAR Medicaid managed care program. “The allegations concerning Superior’s actions, such as actions that were characterized as potentially blackmailing lawmakers to secure state contracts and surveilling private citizens to avoid paying legitimate claims, are deeply troubling,” Paxton said. “I will get to the bottom of this, uncover any illegal activity, and hold bad actors responsible. Justice will be served.” Sanders said during the hearing that “the information gathered was nothing beyond what was publicly available.” But according to The Dallas Morning News, Sanders was fired after the hearing.  

If their annual filings with federal regulators are any indication, major U.S. health insurers know they have a public-perception problem — and they are concerned by it. But the big question, according to health policy and public relations experts, is how they plan to turn things around. 

“For decades, the insurance industry has been acting its way into this reputation,” says Max Marcucci, who leads the global risk and reputation practice at Leidar, a communications consultancy. At each firm, “there probably needs to be some real reflection on…what actions could we take, as a company, to try to change people’s perceptions?”  

While Mehmet Oz, M.D., was noncommittal about his stance on Medicaid funding cuts, the nominee for CMS administrator during a March 14 Senate Finance Committee hearing voiced clear support for requiring some Medicaid beneficiaries to prove employment to keep receiving benefits.  

According to one Wall Street analyst, such strong backing for Medicaid work requirements bodes ill for managed care insurers — not just because of potential enrollment loss, but because it could also make the whole risk pool more expensive to cover. 

Since Donald Trump returned to the presidency, officials in several states have moved to resurrect their Medicaid work requirements demonstrations. During the confirmation hearing of Mehmet Oz, M.D., Trump’s pick to lead CMS, Oz also signaled that he supports Medicaid work requirements. However, if Congress passes a federal Medicaid work requirement, millions of beneficiaries could lose eligibility for health care coverage, according to recent studies.

During Trump’s first term, CMS approved 13 Section 1115 waivers that conditioned Medicaid coverage on meeting work and reporting requirements, but most were either struck down by federal judges or never implemented. The Biden administration then withdrew the waivers in all states. The only work mandate in effect is in Georgia, after the state successfully sued the Biden administration over its decision to rescind the state’s waiver. The state partially expanded Medicaid while also implementing work requirements in 2023, but its Georgia Pathways to Coverage program enrolled only 6,948 people as of Feb. 28, 2025, roughly 75% fewer than the state had estimated. As of January, the program had a backlog of 16,000 applications awaiting processing, according to the state’s documents.